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Drug Interactions between AccessPak for HIV PEP Expanded with Viracept and Tritec

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

raNITIdine bismuth citrate tenofovir

Applies to: Tritec (ranitidine bismuth citrate) and AccessPak for HIV PEP Expanded with Viracept (emtricitabine / nelfinavir / tenofovir)

MONITOR: Coadministration of tenofovir with other drugs that are also eliminated by active tubular secretion may result in increased plasma concentrations of tenofovir and/or the coadministered drug(s) due to competition for renal excretion. Drugs that are thought to undergo active tubular secretion include acyclovir, amiloride, cidofovir, cimetidine, flecainide, ganciclovir, metformin, midodrine, procainamide, quinidine, ranitidine, triamterene, valacyclovir, and valganciclovir.

MANAGEMENT: Patients receiving tenofovir in combination with other drugs that undergo active tubular secretion should be monitored for excessive pharmacologic effects of all drugs, and the dosages adjusted as necessary. Because tenofovir is associated with dose-related nephrotoxicity, especially proximal renal tubulopathy, renal function tests including serum creatinine, serum phosphorous, estimated creatinine clearance, urine glucose, and urine protein should be performed prior to and during therapy. Patients with renal insufficiency at baseline or during treatment may require dosage adjustment in accordance with the manufacturer's product labeling. Persistent or worsening bone pain, pain in extremities, fractures, and/or muscular pain or weakness may also be manifestations of proximal renal tubulopathy and should prompt an evaluation of renal function in at-risk patients.

References

  1. (2001) "Product Information. Viread (tenofovir)." Gilead Sciences
  2. (2017) "Product Information. Vemlidy (tenofovir)." Gilead Sciences

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Minor

raNITIdine bismuth citrate nelfinavir

Applies to: Tritec (ranitidine bismuth citrate) and AccessPak for HIV PEP Expanded with Viracept (emtricitabine / nelfinavir / tenofovir)

There is currently no information in the medical literature regarding a potential interaction between nelfinavir and H2-receptor antagonists. Nelfinavir peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin) decreased by 37%, 36% and 39%, respectively, when nelfinavir (1250 mg twice daily) was coadministered with omeprazole (40 mg once daily 30 minutes before nelfinavir) for 4 days, presumably due to decreased solubility of nelfinavir as gastric pH increased. Although theoretically possible, it is not certain to what extent such an interaction may occur with H2-receptor antagonists, or whether it is clinically relevant. Caution may be advisable during coadministration.

References

  1. (2001) "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc

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Drug and food interactions

Minor

tenofovir food

Applies to: AccessPak for HIV PEP Expanded with Viracept (emtricitabine / nelfinavir / tenofovir)

Food enhances the oral absorption and bioavailability of tenofovir, the active entity of tenofovir disoproxil fumarate. According to the product labeling, administration of the drug following a high-fat meal increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of tenofovir by approximately 14% and 40%, respectively, compared to administration in the fasting state. However, administration with a light meal did not significantly affect the pharmacokinetics of tenofovir compared to administration in the fasting state. Food delays the time to reach tenofovir Cmax by approximately 1 hour. Tenofovir disoproxil fumarate may be administered without regard to meals.

References

  1. (2001) "Product Information. Viread (tenofovir)." Gilead Sciences

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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